MEDICARE: OUTPATIENT PSY CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	103G00000X	Clinical Neuropsychologist	PY5395	FL
4	103TC0700X	Clinical Psychologist	PY5395	FL

General Provider Information

NPI Number	:	1306897954
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUTPATIENT PSY CARE INC

Provider Business Mailing Address
First Line	:	PO BOX 347604
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33234-7604
Country	:	US
Telephone Number	:	305-984-8422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3271 NW 7TH ST.
Second Line	:	SUITE # 203
City	:	MIAMI
State	:	FL
Zip	:	33125
Country	:	US
Telephone Number	:	786-220-6902
Fax Number	:	866-726-0526

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VIVIAN D.J. GONZALEZ-DIAZ
Credential	:	PH.D
Telephone Number	:	786-220-6902

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/02/2024

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Directions to “OUTPATIENT PSY CARE INC ” Practice Location

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